Pakati pa kukambitsirana kwa AHCA, kusakhazikika komwe kumachitika m'misika ya inshuwalansi
Pamene Donald Trump adapambana chisankho cha pulezidenti mu November 2016, tsogolo la Care Affordable Care Act (aka Obamacare) silinadziwikire mwadzidzidzi .
A ACA anakumana ndi mavuto omwe kale adakhalapo, kuphatikizapo khoti la Supreme Court la 2012 lomwe linapeza lamulo lalamulo kuti likhale lokhazikika (koma osati lamulo lowonjezera Medicaid kuti likhalebe ndi ndalama za Medicaid ), ndi mlandu wa Khoti Lalikulu la 2015 lomwe ACA zopereka zothandizira ndalama zatsimikiziridwa kuti zikhale zovomerezeka ku boma lililonse.
Ndipo ndithudi, pakhala pali chingwe chophwanya malamulo pa lamulo kuyambira pomwe adakhazikitsidwa. Palibe imodzi mwa malamulo omwe analipo kale, komabe, chifukwa cha pulezidenti Obama pulogalamu ya veto.
Zinthu zinkawoneka mosiyana kwambiri kuyambira pa 9 November, 2016. Ndili ndi Republican ambiri omwe ali m'chipinda cha Congress, ndi Republican ku White House omwe adayesetsa kuti awononge ACA kunja kwa zipata, adawoneka akuchepa GOP kuti apange zabwino pazaka zisanu ndi ziwiri za malonjezo kuti abwezeretse ACA.
Koma ACA yakhala yogwirizana kwambiri ndi dongosolo la inshuwalansi yathu, ndipo chiwerengero cha anthu omwe ali ndi inshuwaransi yachuma chawonjezeka ndi pafupifupi mamiliyoni 20 chifukwa cha ACA (makamaka kudzera kuwonjezeka kwa Medicaid komanso kugawidwa kwa malonda, ngakhale ena ali achinyamata akulu omwe adapeza chithandizo pazinthu za makolo awo). Kubwereza ndi / kapena kubwezeretsa ACA kunatsimikiziranso kukhala kovuta kuposa momwe kunaonekera poyamba.
Kodi N'chiyani Chimachitika Kwambiri?
Mu Januwale, Trump asanayambe kugwira ntchito, Congress inadutsa S.Con.Res.3, ndondomeko ya bajeti yomwe inachititsa kuti mpira ukugwedezeka pokonzanso zochitika za ACA. Chigamulochi chinawongolera makomiti osonkhana kuti akhazikitse lamulo la mgwirizanowu lomwe lingagwiritsidwe ntchito kubwezeretsa kapena kusintha kusintha kwa ACA zomwe zimakhudza momwe boma liyenera kukhalira (kubwezeretsa ngongole ndi umboni wotsutsa, kotero iwo akusowa zambiri zopitirira, zoperewera , komabe, kuzinthu zomwe zimakhudza kwambiri bajeti).
Makhalidwe angapo a malamulo osagwirizanitsa okhudzana ndi ACA adayambitsidwa kumayambiriro kwa chaka cha 2017 , koma palibe omwe adapitapo patsogolo kuti avote. Bill of reconciliation yomwe inachokera muyeso ya ndondomeko ya bajeti ya America - American Health Care Act, kapena AHCA-inayambidwa kumayambiriro kwa mwezi wa March.
Koma patadutsa masiku 18 a mautumiki ofulumira komanso kusintha kwa mphindi zapitazi, Paul Ryan (R, Wisconsin) adatulutsa mphindi zochepa kuti Nyumbayi isavomereze pa March 24. Posakhalitsa pambuyo pake, Ryan adakamba nkhani yaifupi yomwe adanena kuti ACA idakali pano kuti ikhale yodalirika, ndipo a Republicanwo adzapita patsogolo kuzinthu zina.
Komabe, maganizo amenewo anali ochepa. Kumayambiriro kwa sabata yotsatira, Ryan adanena kuti AHCA yayambiranso patebulo. Nyumba ya Freedom Caucus, gulu lodziimira la Representative Representatives, pamodzi ndi ena olemba malamulo pamapeto pake, adalimbikitsa kwambiri kugonjetsa ACA, ndipo sanafune kuleka mwamsanga.
Nchifukwa chiyani AHCA inalepheretsa Nthawi Yoyamba Kuzungulira?
A Republican ali ndi ambiri mu Nyumba, koma ngati a Republican oposa 22 amasiyana ndi phwando lawo, chiyeso sichitha.
Pa chiwonetsero cha March pa AHCA, panali a Republican osachepera 33 omwe sankatsatira malamulo (a Democrats anali otsutsana nawo).
Koma a Republican awo 33 sanali ogwirizana pa malingaliro awo; iwo anali ndi zifukwa zosiyana zotsutsana ndi AHCA. Pulezidenti wa Freedom Caucus adakhulupirira kuti lamuloli silinathetseretu kupititsa patsogolo ACA, lomwe akufuna kuti liwonongeke (malamulo a chiyanjano sangathe kuwononga ACA, koma Freedom Caucus mamembala akufuna kuti biloyi ikhale yaikulu kwambiri ngati HR3762, yomwe inavomerezedwa ndi Purezidenti Obama mu 2016).
Ndipo pamapeto pake, omvera malamulo akudandaula za momwe CBO imawonetsera kuti anthu osalimbikitsidwa adzakula ndi anthu 24 miliyoni pa zaka 10 zikubwera pansi pa AHCA, komanso za kusintha kwa AHCA kuwonjezereka kwa Medicaid komanso Medicaid.
Kodi chikuchitika ndi chiani?
Pofika kumayambiriro kwa mwezi wa April, nyumba za Republic Republic, zomwe zakhazikika ndi Pulezidenti Pulezidenti Mike Pence, ndi Mlembi wa HHS, Tom Price, adawoneka kuti atsala pang'ono kumasula malamulo awo, koma adakali kukambirana za kusintha kumeneku kudzaphatikizidwa.
Vutoli linayambira chifukwa chakuti kutsutsa kwa Republican kunayamba kuchokera kuzigawo zochepa komanso anthu omwe ali kumapeto kwenikweni kwa ndale. Zosintha zomwe zatchulidwa kuti zikhale zokondweretsa mamembala a ufulu wa Avocat ndi otsimikiza kuti alekanitsa Republican, komanso mosiyana.
Poyamba, atsogoleri a Pence ndi a Republican akupempha kuti apeze njira yowonjezera yomwe ingati ikhonza kugwiritsira ntchito kusintha kwa zofunikira zaumoyo wa ACA komanso kuletsa kwa ACA kukhazikitsa malipiro a inshuwalansi pa zachipatala. Mamembala a ufulu wa Caucus akufuna mayiko kuti athe kufotokozera zofunikira zawo za umoyo zofunika, kuti athe kuchepetsa kuchuluka kwa zomwe zingapangidwe ndi inshuwalansi ya umoyo. Amafunanso kuthetseratu chizoloŵezi cha anthu omwe ali ndi thanzi labwino komanso odwala omwe amapereka malipiro omwewo.
Pansi pa ACA, malipiro amatha kukhala osiyana malinga ndi msinkhu wa zaka (ndi chiwerengero cha 3: 1 chiwerengero cha olembetsa achikulire motsatira olembetsa achinyamata), kugwiritsa ntchito fodya (mwa chiwerengero cha 1.5: 1), ndi zip code. Koma mbiri yachipatala ya wolembayo si mbali ya equation.
Pambuyo pa 2014, makampani a inshuwalansi a zaumoyo m'mayiko ambiri akhoza kupenda mbiri yakale ya ogwira ntchito ndikugwiritsira ntchito chidziwitsochi kuti apeze ndalama zoyenera. Iwo akhoza kukana mapulogalamuwo mwangwiro ngati zikhalidwe zomwe zisanachitike zinali zovuta. Kusinthidwa kumeneku kukonzedwa kwa AHCA sikungalole inshuwalansi kukana zofuna zokhudzana ndi mbiri yachipatala, koma otsutsa ananena kuti ngati ndalama zowonjezera zikhoza kuwonjezeka kwambiri kwa opempha odwala, zikanakhala zotsimikizira kuti ACA imateteza anthu omwe alipo kale. Izi ndizoona makamaka ngati boma liyenera kusintha ndondomeko zofunikira za umoyo wa ACA, ngati wopempha angapeze kuti zinthu zomwe analipo kale zakhala "zitaphimbidwa" koma ndondomekoyi siipereka phindu pamalo osowa ofunika.
Pofuna kukondweretsa Republican ochepa, chinthu china chinayambanso. Zingalole kuti mayiko adzalandire ndalama zothandizira kuti asinthe malingaliro othandizira azaumoyo komanso chiwerengero cha ACA's premium age (kotero kuti okalamba akuluakulu angapereke ndalama zokwana maulendo oposa asanu, koma katatu), koma salola kuti payimayi ipangidwe mbiri yachipatala ya olemba.
Pofika pa Epulo 5, kusiyana pakati pa ziganizo ziwirizi kunachititsa kuti nkhaniyi iwonongeke, kwa kanthawi. Amuna Akuluakulu a Caucus safuna kuti apitirize popanda chitsimikizo chomwe chidzanena kuti adzalola olemba inshuwalansi kuti abwerere kuchipatala kuti apereke malipiro awo, chifukwa amakhulupirira kuti izi ndizofunikira kuti athetse malipiro a anthu ambiri (ie, omwe alibe zikhalidwe zomwe zakhalapo kale).
Ndipo pamapeto ena a dzikoli, a Republican amakhulupirira kuti kubwerera ku malipiro okhudzana ndi mbiri yachipatala kungathetsere kuteteza kwa ACA kwa anthu omwe alipo kale, zomwe ndi zofunikira kwambiri pa malamulo.
Olemba malamulo apanga kugwiritsa ntchito ndalama zomwe zinaperekedwa mu AHCA kuti mayiko athe kukhazikitsa misika yawo ya inshuwalansi, ndipo m'malo mwake aziyika ku malo osungirako amadzi . Madzi oterewa angapangitse anthu omwe ali ndi nthawi zomwe zakhalapo kale zomwe zimagulitsidwa kunja kwa msika. Mayiko 35 anali ndi madera akuluakulu omwe asanakhalepo ku ACA, ndipo anali ndi ndalama zambiri. Kubwerera kumadzi omwe ali pangozi ndi njira yothetsera mavuto ndipo kungafunike ndalama zochuluka kusiyana ndi zomwe madziwa adalandira kale.
Kodi Timachokera Kuti?
Ngakhale Trump ndi Pence atsimikiza kuti ntchito ikubwera posachedwa, zokambirana zikuwoneka kuti zatha, ndipo sipanakhale kusintha kwina kulikonse kwa AHCA. Kukambirana kukanatha kupitiliza kumapeto kwa kasupe, koma mwina mwina sikokwanira pakati pa mapeto onse a nthumwi ya Republican kuti agwirizane panjira.
Ngati malamulo saperekedwa kuti asinthe kapena kusintha ACA, idzakhala lamulo la dzikolo. Komabe, tsogolo lawo ndidadalira kwambiri zochita zomwe Trump Administration ingatenge.
Ogwirizanitsa akhala akunena miyezi yomwe akufunika kuti athe kuonetsetsa kuti malonda ena akuyendera kuti apitirize kupereka chithunzi mu 2018. Awiri Insurers-Humana, ndi Wellmark-a Iowa adalengeza kale kuti sadzalowa nawo ku ACA- msika wokondweretsa wina chaka chatha, ndipo ena angatsatire ngati akuwona kuti pali zovuta kwambiri pa zomwe zikuchitika kenako.
Nyumba v. Mtengo: Kugawanika kwa Ndalama Zopatsa Ndalama
Milandu ya ACA yothandizira ndalama zomwe zikugwiritsidwa ntchito pompano ndizo zomwe zili ndi mlandu (House v. Price, yomwe kale inali Nyumba v. Burwell) yomwe inalembedwa ndi House Republicans mu 2014. Olemba malamulo (omwe adawaphatikizapo Tom Price, amene adaimira Boma la 6 ku Nyumbayi patsogolo kuti asankhidwe ndi Trump kuti atsogolere HHS, komwe tsopano ali wotsutsa pa mlanduwu) akunena kuti ndalama zothandizira ndalama zimaperekedwa molakwika, popeza ndalama sizinaperekedwe ndi malamulo. Sutu yawo inali yoyenera, ndipo woweruza milandu wa chigawo cha chigawo adagonjetsa iwo mu May 2016.
Boma la Obama linakondweretsa, zomwe zinapangitsa kuti pakhale ndalama zothandizira ndalama zopita kwa inshuwalansi pakalipano. Pambuyo pa Trump atagonjetsa chisankho, House Republican adafunsa kuti mlanduwu ukhazikitsidwe pamene akukonzekera tsogolo la ACA. Lipoti la udindo liyenera kubwalo la milandu pa May 22.
Ngati a Republic Republican akutsutsa nkhaniyi, kapena ngati Congress ikuganiza kupititsa malamulo kuti pakhale ndalama zothandizira ndalama, House v. Mtengo wotsika umatha. Komabe, ngati Boma la Trump likutsutsa pempho limene Obama Administration adayambitsa, msika wina uliwonse ukanakhala ukugwera kwakukulu (omwe ali ndi inshuwalansi ali ndi chigamulo chothawirako muzigwirizano zawo ndi HealthCare.gov zomwe zimawalola kuti asiye kusinthanitsa ngati kulipira -kuthandizira thandizo kumachotsedwa).
Kulimbitsa Msika
Mu February 2017, HHS idapanga kusintha kwa mitundu yosiyanasiyana pofuna kuthetsa msika. Koma panthawi imodzimodziyo, tsiku la Trump limodzi lolamulira lomwe likutsogolera mabungwe a federal kukhala ololera pakugwira ntchito kwa ACA ali ndi zotsatira zosiyana.
Mwachitsanzo, IRS idakonza kukhala yowongoka kwambiri potsata momwe anagwiritsira ntchito ma msonkho a chaka cha 2016 ponena za udindo wa ACA. Koma motsatira ndondomeko yoyendetsera ntchitoyi, iwo adasintha njirayo pazokha, ndipo akukonzekera akubwezeretsa momwemo momwe adachitira m'mbuyomu . Chilichonse chomwe chimathandiza kuchepetsa udindo wa munthu aliyense pamapeto pake chimachepetsa mtendere wa misika ya inshuwalansi, ngati anthu ocheperapo thanzi amalembetsa kufalitsa.
Kodi Chotsatira N'chiyani?
Panthawiyi, tsogolo la ACA ndi 2018 malonda a inshuwalansi zaumoyo alionse ali mlengalenga. A Republican lawmakers ndi White House akugwira ntchito kuti atsitsimutse AHCA, koma sadziwa ngati adzatha kuchita zimenezo. Ngakhale kuti ACA imakhala yosasunthika, komabe makampani a inshuwalansi omwe amagwira bwino ntchito amafunikira malamulo osakhazikika, ndalama zowonjezera, komanso dziwe labwino. Sitikudziwa momwe zonsezi zidzakhudzira miyezi ingapo yotsatira.
> Zotsatira:
> Congress.gov, HR1628 - American Health Care Act wa 2017. Congress ya 115 (2017-2018).
> Congress.gov. S.Con.Res.3. Congress ya 115 (2017-2018)
> Bungwe la Congressional Budget Ofesi Yowonjezera Mtengo, American Health Care Act , March 13, 2017. (kuphatikizapo kukonzedweratu pa March 23, 2017)
> Dipatimenti ya zaumoyo ndi zithandizo zaumunthu, Chitetezo cha odwala komanso ndalama zothandizira pazinthu zogulitsa, Kulimbitsa Msika , chidziwitso cha kuphulika kwa ndalama. February 2017.
> Garrett, Bowen; Gangopadhyaya, Anuj; Institute of Urban, Amene Anapeza Inshuwalansi Zaumoyo Pansi pa ACA ndipo Ali Kuti ? December 2016.